Vermont Gov. Peter Shumlin made history earlier this year when he signed into law legislation that would make his state the first state to lay the groundwork for a single payer health care system.  Vermont begins building a single-payer health system that will move many state residents into a publicly financed insurance program and pay hospitals, doctors and other providers a set fee to care for patients.   "Under the plan, single payer coverage will be a right and not a privilege, and will not be connected to employment," he wrote in a recent blog post. "This is groundbreaking. But our success in guaranteeing coverage depends on our ability to control health care costs, so our plan is focused squarely on that goal."

Now, another governor is looking to take advantage of flexibility in Obama’s health care law in order to establish a single payer system in his state. Gov. Brian Schweitzer (D-MT) announced that he will be seeking a waiver to set up his own universal health care system in his state modeled after the single payer Canadian health care system.

Gov. Brian Schweitzer will ask the U.S. government to let Montana set up its own universal health care program.  The popular second-term Democrat would like to create a state-run system that borrows from the program used in Saskatchewan. He said the Canadian province controls cost by negotiating drug prices and limiting non-emergency procedures such as MRIs.

Here are some of the issues involved:

Green Mountain Care would be a state-funded-and-managed insurance pool that would provide near-universal coverage to residents while reducing health care spending.   The law allows for either a completely public system or a public-private venture where the state could contract out some administrative functions to private insurers. Employers with self-insured plans (usually large companies) would be able to keep their current health coverage.

 Supporters say that a single-payer system is friendly to consumers and providers and will help reduce the rate of health-care cost increases. A Commonwealth Fund report concluded that such a system could cut health care spending by 25 percent after it is fully implemented. After adding coverage for the uninsured and expanding other services, including dental care, the system would save Vermont households and employers nearly $200 million in the first year alone. Savings would come primarily from lower administrative expenses, reduced fraud and abuse, greater delivery system integration and malpractice reform. The report also found that the system would create about 3,800 new jobs and increase the state’s total economic output by more than $100 million in 2015.

Dr. David Himmelstein, a professor at the City University of New York’s School of Public Health and a proponent of a national single payer system, said: "If they follow through like they say they would, it would be a fabulous thing, an enormous gift to the nation."

Meanwhile, some single-payer advocates believe that the new system does not go far enough. Himmelstein said that the law should be more explicit about not having copayments and deductibles and make a greater commitment to global budgeting, in which providers pay for a patient’s healthcare with a set fee for the year.

 

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